Tetracaine
PONTOCAINE
What it isPotent long-acting ester local anesthetic that blocks voltage-gated sodium channels; used topically and for spinal anesthesia.
Why this oneProvides dense, durable surface or neuraxial anesthesia in very small doses.
What limits itRapid absorption or excess dosing can cause seizures, respiratory arrest, and cardiac arrest; ester metabolism also permits PABA-related allergy.
FDA-approved for
- topical/spinal anesthesia (1941)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Topical ocular (corneal) anesthesia | Adults and pediatric (under HCP supervision) | 1 drop in the eye(s) PRN | 1 drop PRN | 1 drop PRN |
Renal Undefined
Hepatic Undefined
Instructions
- For administration under direct supervision of a healthcare provider; not for patient self-administration
- Not for injection or intraocular/intracameral use
- Patients should not touch the eye for 10–20 minutes after use (insensitivity risk)
Cautions
- Corneal endothelial damage if used intracamerally — not for injection/intraocular use
- Prolonged use or abuse may cause corneal epithelial toxicity and permanent corneal damage
- Corneal injury from insensitivity — avoid touching the eye until sensation returns
- For healthcare-provider administration only
Adverse reactions
- Transient stinging
- Burning
- Conjunctival redness
- Eye irritation
- Eye pain
- Ocular discomfort
Pregnancy No adequate and well-controlled studies in pregnant women
Lactation No data on presence in human milk
NO BOXED WARNINGS
Principal risklocal-anesthetic systemic toxicity with seizures or cardiac arrest
Cost, est. cash$10–$400/month
Generic entryBy 2023
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityLocal tissue injury and inadvertent systemic exposure can cause seizures or cardiovascular toxicity.
Mechanism of action: Tetracaine ballicule
